Albumin function in acute-on-chronic liver failure (ACLF): Effect of plasma exchange with albumin 5% (PE-A5%)

2018 ◽  
Vol 68 ◽  
pp. S244
Author(s):  
M. Torres ◽  
R. Horrillo ◽  
N. Afonso ◽  
L. Nunez ◽  
A.M. Ortiz ◽  
...  
Keyword(s):  
Liver Failure ◽  
Plasma Exchange ◽  
Chronic Liver ◽  
Chronic Liver Failure

Therapeutic plasma exchange in acute on chronic liver failure

2020 ◽  
Vol 35 (4) ◽  
pp. 316-327
Author(s):  
Klaus Stahl ◽  
Markus Busch ◽  
Jan Fuge ◽  
Andrea Schneider ◽  
Michael P. Manns ◽  
...  
Keyword(s):  
Liver Failure ◽  
Plasma Exchange ◽  
Chronic Liver ◽  
Therapeutic Plasma Exchange ◽  
Chronic Liver Failure

scholarly journals Good Tolerance of Citrate Accumulation due to Plasma Exchange among Patients with Acute-on-Chronic Liver Failure: A Prospective, Observational Study

2018 ◽  
Vol 2018 ◽  
pp. 1-10 ◽  
Author(s):  
Yuanji Ma ◽  
Yan Xu ◽  
Fang Chen ◽  
Ying Wang ◽  
Lang Bai ◽  
...  
Keyword(s):  
Observational Study ◽  
Liver Failure ◽  
Plasma Exchange ◽  
Prospective Observational Study ◽  
Meld Score ◽  
Chronic Liver ◽  
Ionized Calcium ◽  
Chronic Liver Failure ◽  
Citrate Accumulation ◽  
The Mean

Aim. To assess the tolerance of citrate accumulation due to plasma exchange (PE) among patients with acute-on-chronic liver failure (ACLF). Methods. A prospective, observational study was conducted among patients with ACLF who received heparin anticoagulation during PE-centered therapy without filtration and dialysis. Citrate accumulation was defined as the value of total calcium (Catot) to ionized calcium (Caion) ratio (Catot/Caion) greater than or equal to 2.5 (Catot/Caion≥2.5). Results. Fifty-four patients were enrolled. The mean age and MELD score were 50.0 ± 11.3 years old and 25 ± 7, respectively. Thirty-three patients had liver cirrhosis. The total 3-month survival rate was 57.4% (31/54). The mean Catot/Caion at the time before PE was 2.05 ± 0.14. Catot/Caion≥2.5 occurred in 100.0% (54/54) and 29.6% (16/54) of patients with mean Catot/Caion of 4.34 ± 1.52 and 2.36 ± 0.32 immediately after PE and 1 hour after PE, respectively, and these levels were much higher than those before PE (p<0.01). However, all values returned to lower than 2.5 by the next morning with no difference from those before PE (2.10 ± 0.14 versus 2.05 ± 0.14, p>0.05). Hypocalcemia (ionized calcium) and mild alkalosis were the main metabolic alterations. No symptoms associated with hypocalcemia occurred. Conclusions. Citrate accumulation is well tolerated by patients with ACLF who receive PE-centered therapy without filtration and dialysis. This study is regeristed with ChiCTR-OOC-17013618.

scholarly journals Plasma exchange in patients with acute and acute-on-chronic liver failure: A systematic review

2020 ◽  
Vol 26 (2) ◽  
pp. 219-245 ◽  
Author(s):  
Eunice Xiang-Xuan Tan ◽  
Min-Xian Wang ◽  
Junxiong Pang ◽  
Guan-Huei Lee
Keyword(s):  
Systematic Review ◽  
Liver Failure ◽  
Plasma Exchange ◽  
Chronic Liver ◽  
Chronic Liver Failure

Plasma Exchange in Acute and Acute on Chronic Liver Failure

2021 ◽  
Author(s):  
Rakhi Maiwall ◽  
Shiv K. Sarin
Keyword(s):  
Liver Failure ◽  
Plasma Exchange ◽  
High Volume ◽  
Chronic Liver ◽  
Toxic Substances ◽  
Chronic Liver Failure ◽  
Liver Support ◽  
Basic Premise ◽  
Extracorporeal Blood Purification ◽  
Purification Technique

AbstractLiver failure in the context of acute (ALF) and acute on chronic liver failure (ACLF) is associated with high mortality in the absence of a liver transplant. For decades, therapeutic plasma exchange (TPE) is performed for the management of immune-mediated diseases. TPE has emerged as an attractive extracorporeal blood purification technique in patients with ALF and ACLF. The basic premise of using TPE is to remove the toxic substances which would allow recovery of native liver functions by facilitating liver regeneration. In recent years, encouraging data have emerged, suggesting the benefits of TPE in patients with liver failure. TPE has emerged as an attractive liver support device for the failing liver until liver transplantation or clinical recovery. The data in patients with ALF suggest routine use of high-volume TPE, while the data for such a strategy are less robust for patients with ACLF.

Safety and Efficacy of Regional Citrate Anticoagulation during Plasma Adsorption Plus Plasma Exchange Therapy for Patients with Acute-on-Chronic Liver Failure: A Pilot Study

2019 ◽  
Vol 48 (3) ◽  
pp. 223-232 ◽  
Author(s):  
Yuanji Ma ◽  
Fang Chen ◽  
Yan Xu ◽  
Ming Wang ◽  
Taoyou Zhou ◽  
...  
Keyword(s):  
Pilot Study ◽  
Liver Failure ◽  
Plasma Exchange ◽  
Chronic Liver ◽  
Regional Citrate Anticoagulation ◽  
Chronic Liver Failure ◽  
Safety And Efficacy ◽  
Citrate Anticoagulation ◽  
Citrate Accumulation ◽  
Heparin Anticoagulation

Background: Patients with acute-on-chronic liver failure (ACLF) might be at risk for citrate accumulation during plasma adsorption plus plasma exchange (PE) therapy with regional citrate anticoagulation (RCA). Objectives: To assess the safety and efficacy of RCA during double plasma molecular adsorption system (DPMAS) plus PE therapy for patients with ACLF. Method: A prospective nonrandomized controlled pilot study was conducted at West China Hospital of Sichuan University. Patients with ACLF were enrolled to heparin anticoagulation (HA) group and RCA group. Serial blood samples were taken. Patients were followed up for 3 months. Results: Twenty-four patients with 94 sessions of HA and 28 patients with 106 sessions of RCA were enrolled. RCA method did not affect the therapeutic efficacy, the function of extracorporeal circulation, and the prognosis of these patients. The occurrences of citrate accumulation in RCA group were 0.0, 67.0, 100.0, 34.0, and 0.0% before DPMAS therapy, at the end of DPMAS therapy, immediately after PE therapy, 2 h after PE therapy, and the next morning, while that in HA group were 0.0, 0.0, 100.0, 7.4, and 0.0%, respectively. The occurrences of citrate accumulation at the end of DPMAS therapy and at 2 h after PE therapy in RCA group were much higher than that in HA group (67.0 vs. 0.0%, p = 0.000; 34.0 vs. 7.4%, p = 0.000, respectively). Although the trend of citrate accumulation in RCA group was much more obvious than that in HA group during and after DPMAS plus PE therapy (p = 0.000), the values on the next morning were similar between the 2 groups (p > 0.05). The main alteration of acid–base status was metabolic alkalosis with no difference between the 2 groups. Conclusions: RCA might be safe and effective in patients with ACLF receiving plasma adsorption plus PE therapy. RCA method might offer an alternative anticoagulation method for them.

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